Audiologist to ENT Surgeon Referral Form

Streamline Specialist Referrals with Paperform

When you're an audiologist referring patients to ENT surgeons, clear communication of clinical findings is essential for continuity of care. This Audiologist to ENT Surgeon Referral Form template helps audiology practices, hearing clinics, and ENT networks document comprehensive patient information—from audiometry results and tinnitus severity to balance assessments and cochlear implant candidacy—all in one professional, structured form.

Built with Paperform, this template gives you a doc-style editor that feels natural to use, with conditional logic that adapts questions based on patient presentation. Whether you're assessing vestibular symptoms, documenting speech discrimination scores, or flagging urgent surgical candidates, the form captures everything your ENT colleagues need for efficient triage and treatment planning.

Why healthcare providers choose Paperform

Paperform is trusted by healthcare practices worldwide for patient intake, referrals, and clinical workflows. With SOC 2 Type II compliance and robust security features, your patient data stays protected while you maintain seamless communication between providers.

Use conditional logic to show relevant follow-up questions only when needed—balance assessment fields appear only when patients report dizziness, and cochlear implant sections expand for profound hearing loss cases. Attach supporting documents like audiograms, tympanometry reports, or MRI results directly to the referral, keeping all clinical information in one place.

Automate your referral workflow with Stepper

Once a referral is submitted, use Stepper to automate your entire referral workflow. Route urgent cases to the ENT surgeon's office immediately, send routine referrals through your standard triage process, update your practice management system automatically, and trigger confirmation emails to both the referring audiologist and the receiving specialist. This means faster patient access to care and less administrative burden on your team.

Whether you're a solo audiology practice, a multi-location hearing clinic, or part of an integrated ENT and audiology network, this template helps you deliver professional, comprehensive referrals that improve patient outcomes and strengthen your specialist relationships.